Statement of the Problem. Patients and families consistently rate end-of-life communication skills as vital to high- quality care and consistently report deficiencies in the quality of clinician communication around patient goals, values and beliefs. The accrediting bodies for medical schools, graduate medical education, and nursing schools all mandate communication training as a core competency. Thus, many programs have been developed to improve the quality of clinician-patient communication but for the most part they have not improved patient-centered outcomes. This may be in part due to limitations of traditional assessment methods that focus more on the quantity of communication behaviors (ie. whether they occur) without attention to their quality. Experts agree that a better, theory-driven assessment tool that captures the dynamic and complex way that end-of-life communication occurs is needed to improve communication, shared decision-making, and patient-centered outcomes. Specific Aims. This project will adapt a theory-based, validated communication assessment tool, Communication Quality Analysis (CQA), for use in clinician-patient encounters. Currently, CQA relies on transcribed recordings to analyze the conversations, precluding its routine use of CQA for assessing real-time encounters and provision of in-the-moment feedback. The main objectives of this study are to assess whether CQA can be reliably applied to standardized patient (SP) encounters and whether real-time coding CQA scores are comparable to those of the transcript-based CQA methodology. Secondary analyses will compare CQA scores to SP assessments of communication quality. Study Design. Conversations between medical or nursing trainees and SPs (108 conversations) will be video recorded, transcribed and coded by 8 trained coders. Four coders will code transcripts and 4 will code the video recordings without transcripts or pausing/rewinding the video to simulate a live encounter. Inter-rater reliabilities will be analyzed for both coding groups. To determine how well the transcript and real-time coding methods agree with each other, we will invoke generalizability theory by constructing a nonlinear mixed-effects model (accounting for repeated measurements on each trainee, the trainee?s gender, coder, and standardized patient encounter). A similar model will compare CQA scores to SP assessments of the trainees. Significance of the Results. The development of a theory-driven, easily implementable, and reliable communication assessment methodology offers a powerful educational tool to advance trainees? understanding of their communication performance that may improve how they discuss patient goals, values and beliefs. The success of this project will position us to explore: 1) using real-time CQA feedback as a teaching tool; 2) applying CQA to real patient encounters; and 3) using CQA to assess the efficacy of communication trainings on shared decision-making and patient-centered outcomes.